Prevention Of Thrombotic Complications Research Articles

Low Versus Standard Intensity Heparin Protocols in Adults Maintained on Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study

Background: Patients maintained on extracorporeal membrane oxygenation (ECMO) often require systemic anticoagulation to prevent circuit clotting and systemic thromboembolic complications. The optimal intensity of anticoagulation to balance the risk of bleeding and prevention of thrombotic complications in this patient population is not well described. Objective: To compare bleeding events in patients on ECMO anticoagulated with standard vs low intensity heparin protocols. Methods: This single-center, retrospective cohort study included adult patients on VA- or VV-ECMO and anticoagulated with low or standard intensity heparin protocols. The primary outcome was the incidence of major bleeding; secondary outcomes included the incidence of minor bleeding, thrombotic complications, heparin-induced thrombocytopenia, in-hospital mortality, time in therapeutic range, anti-Xa correlation with aPTT, intensive care unit and hospital lengths of stay, oxygenator exchanges, and rate of protocol switching. Results: A total of 27 patients (14 low intensity, 13 standard intensity) were included. There were six major bleeding events in the low intensity group and four in the standard intensity group ( P = 0.69); there were four minor bleeding events in the low intensity group and five in the standard intensity group ( P = 0.69). Seven patients in the standard intensity group switched protocols; zero patients in the low intensity group switched protocols ( P = 0.002). There were no differences in any other outcomes. Conclusions: There was no difference in the incidence of any bleeding or thrombotic events when using a low vs standard intensity heparin protocol in patients on ECMO. A low intensity heparin strategy for patients on ECMO may be feasible and safe.

Genetic factors of thrombosis <i>FII G20210A</i>, <i>FV G1691A</i> (<i>Arg506Gln</i>) in patients with thoracoabdominal malignant tumors

Introduction. Malignant tumor is one of the leading factors of venous and arterial thrombosis. But there is no data on the need for a genetic testing protocol of cancer patients for genetic predisposition thrombotic conditions, despite the fact that a number of polymorphisms of hemostasis genes are considered to be unconditionally proven factors of high cumulative thrombogenic risk, and proteins encoded by these genes are direct links in the cascades of pathological hypercoagulation in neoplastic processes.Aim. To identify groups of high genetic risk of thrombotic complications among patients with malignant thoracoabdominal tumors.Materials and methods. The study included 223 patients with malignant tumors of the lung, stomach, esophagus, operated in the Department of Thoracic Oncology of the N.N. Blokhin National Research Center of Oncology in 2018–2019. The study groups consisted of patients with myocardial infarction (n = 62), ischemic stroke (n = 24), venous thrombosis/ venous thromboembolic complications (n = 40), patients without cardiovascular diseases, but with a family history burdened by cardiovascular diseases (n = 33). The control group included 81 patients.Results. Among patients with malignant tumors of thoracoabdominal localization, a statistically significant difference was determined in the frequency of carriage of the heterozygous genotype FV 1691GA (Arg506Gln) in patients who had a myocardial infarction (χ2 = 4.0; p = 0.046), who had venous thrombosis (χ2 = 4.118; p = 0.043), in the group of patients with burdened with a family history (χ2 = 4.997; p = 0.026) in comparison with the control group. Statistically significant difference in the frequency of carriage of the heterozygous variant of the mutation in the FII G20210A gene relative to the control group, it was determined in the group of patients who had an acute cerebrovascular accident (χ2 = 6.881; p = 0.009) and among patients with a burdened history (χ2 = 7.563; p = 0.006).Conclusion. In order to assess the risk of development and prevention of thrombotic complications in the perioperative period in patients with malignant thoracoabdominal tumors, who have suffered myocardial infarction, ischemic stroke, venous thrombosis/venous thromboembolic complications, as well as patients without cardiovascular pathology, but with thrombotic conditions in relatives of the first degree, it is advisable to perform DNA diagnostics at the prehospital stage to identify of gene polymorphisms FII G20210A and FV G1691A (Arg506Gln).

Prevention of thrombotic complications in patients with AL amyloidosis

Background. The problem of hemostasis system pathology in patients with AL amyloidosis (AL-A) is of great practical importance. Currently, there are no recommendations concerning indications and methods of prevention of thrombotic complications.Aim. To study the main parameters of blood coagulation system in patients with AL amyloidosis, to determine the indications for anticoagulant therapy, to evaluate the efficacy and safety of apixaban prophylactic use during antitumor therapy.Materials and methods. A prospective single-center study included 65 patients with newly diagnosed systemic AL amyloidosis. The median age was 58 (34–74) years. Induction therapy according to the program BorCyDex (bortezomib, cyclophosphamide, dexamethasone) was given to 59 (90 %) patients, of which 5 patients received the combination of BorCyDex with a monoclonal antibody to CD38 – daratumumab. The remaining 6 (10 %) patients were treated with melphalan. Patients with laboratory signs of hypercoagulability or thrombotic complications were treated with apixaban in therapeutic or prophylactic dose. Indications for apixaban therapy in therapeutic dose (10 mg/day): atrial fibrillation, arterial thrombosis or pulmonary embolism less than 1 year ago. Indications for apixaban therapy in prophylactic dose (5 mg/day) were considered the presence of one or more factors: hypoalbuminemia less than 20 g/L; increase in D-dimer level more than 500 ng/mL without instrumentally verified arterial or venous thrombosis; increase in D-dimer level more than 500 ng/mL within 3 months after resolved episode of thrombosis; increase in fibrinogen level more than 4 g/L; increase in FVIII activity more than 150 %. When two or more factors were present, an antiplatelet agent (acetylsacylicylic acid) was added to apixaban therapy. The follow-up period was 4–9 months (median 6 months).Results. Before the start of antitumor therapy, thrombotic complications were diagnosed in 15 (23 %), bleeding – in 3 (5 %) patients. Hemostasis study revealed an increase in one or more laboratory parameters reflecting hypercoagulability in 92 % of patients. Increase in fibrinogen level was found in 70 %, D-dimer – in 72 %, FVIII activity – in 92 % of patients. 3 (5 %) patients received a therapeutic dose of apixaban, 58 (89 %) patients ‒ a prophylactic dose. Therapy with apixaban and antiplatelet agent was performed in 10 (15 %) patients. During the follow-up 3 patients developed complications related to hemostasis system disorders: 1 (2 %) patient had thrombosis (ischemic stroke), 2 (3 %) – gastrointestinal bleeding of mild severity. All these patients received a prophylactic dose of apixaban due to the presence of 1 thrombosis risk factor: an increase in FVIII activity of more than 150 %.Conclusion. Clinical signs of hemostasis system pathology were observed in 28 % of AL amyloidosis patients, and laboratory signs of hypercoagulability were detected in 92 %. Our developed indications for thrombosis prophylaxis in AL amyloidosis were effective. The issue of FVIII activity increase as the only indication for anticoagulant therapy in AL amyloidosis patients requires further research.

Abstract 005: Outcomes of Heparin Induced Thrombocytopenia Type II in Aneurysmal Subarachnoid Hemorrhage Patients

Introduction Heparin‐induced thrombocytopenia (HIT) is a rare complication characterized by a decreased platelet count and hypercoagulability following heparin and light‐molecular weight heparin administration. Both anticoagulants can be used intraoperatively and postoperatively for DVT prophylaxis in patients undergoing subarachnoid hemorrhage (SAH) treatment. Patients with SAH are an understudied population in terms of assessing incidence and impact of HIT. This study aims to investigate the incidence, complications, and outcomes of SAH patients who develop HIT. Methods ICD‐9‐CM and ICD‐10‐CM codes were used to query the National Inpatient Sample for patients with SAH between 2010 and 2019. Subgroup analysis was stratified by HIT development. SAH severity was determined using the National Institute of Health Stroke Scale as a template. Patients from both groups were assessed for baseline clinical characteristics, comorbidities, interventions, complications, and outcomes. Cohorts containing ten or fewer patients must only be described qualitatively. Descriptive statistics, multivariate regressions, and propensity score‐matching were all performed using IBM SPSS 28. Results 76,387 patients were diagnosed with SAH between 2010 and 2019. 166 (.22%) had developed HIT in response to anticoagulant administration. The incidence of HIT was higher in patients who were younger (58.04 vs 61.39, p = 0.01), obese (0.4% vs 0.2%, p < 0.01), on long‐term anticoagulant use (10.84% vs 5.72%, p < 0.01), and had an implanted cerebrospinal fluid drainage device (p < 0.01). Patients with HIT were associated with higher SAH severity (1.42 vs 1.06, p < 0.01). Through both the complete cohort and propensity score‐matched cohort, patients with HIT were associated with higher rates of endovascular coiling, external ventricular drain placement (p < 0.01), and ventriculoperitoneal shunt placement (p < 0.01). HIT patients had significantly higher rates of deep vein thrombosis (p < 0.01), pulmonary embolism (p < 0.01), central venous sinus thrombosis (p = 0.01), pneumonia (p < 0.01), urinary tract infection (p < 0.01), acute kidney injury (p < 0.01), and cerebral vasospasm (p < 0.01). Patients who develop HIT had a longer length of stay (LOS) (24.04 vs 10.48, p < 0.01). HIT continued to be a significant predictor of having an above average LOS (OR: 6.799, CI: 3.985 ‐ 11.6, p < 0.01) when controlling for age, SAH severity, and significant comorbidities. Conclusion Our study revealed that younger SAH patients with various comorbidities are more prone to developing HIT, leading to higher rates of thrombotic events, acute kidney injury, and nosocomial infections, which can significantly prolong their hospital stay. Considering the extended postoperative recovery period for SAH, investigating the causes of HIT can facilitate earlier detection and prevention of thrombotic complications. This nationwide, multicenter, retrospective study provides valuable insights for clinicians on how to prevent and manage HIT in patients with subarachnoid hemorrhage.

Prevention of thrombotic complications in patients in the postoperative period of total hip and knee arthroplasty: efficacy and safety

Thromboembolic complications (TEC) remain a significant problem in modern surgery, worsening the prognosis and reducing the effectiveness of the operation performed. The increase in the number of venous thromboembolisms (VTE) is determined by the severity of the initial injuries, the volume and traumatic nature of the surgical intervention, as well as the increase in the number of elderly patients with multiple comorbidities. Patients in orthopedic departments who have undergone major surgeries such as total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at increased risk of VTE, leading to significant postoperative morbidity and mortality. Thromboses in extensive orthopedic surgery are caused by several prothrombotic mechanisms, such as venous injury, activation of procoagulation factors due to massive bone and tissue damage, and prolonged postoperative immobilization. The most common potential thrombotic complications after arthroplasty are deep vein thrombosis (DVT) of the lower extremities and pulmonary embolism (PE).In the absence of prophylaxis in the postoperative period of major orthopedic surgeries, TECs develop in most patients.To date, the issue of primary prevention of VTE in orthopedic patients remains relevant, and there is still no consensus on the best way to prevent thrombosis after THA and TKA.Risk assessment is the first step in preventing death and disability from VTE. Currently, mechanical and pharmacological methods are used for primary prevention in orthopedics, often in combination. Certainly, the use of antithrombotic drugs in the postoperative period is an effective way to prevent thrombosis. When prescribing antithrombotic drugs, it is also important to minimize the risk of bleeding, including in the area of postoperative wounds. Various antithrombotic drugs are used as pharmacological prophylaxis for TEC. The literature on the dosage, duration, efficacy, and safety of their use varies considerably. Our review assessed published literature on the efficacy and safety of antiplatelet agents for VTE prophylaxis.

Anticoagulant therapy in a hemodialysis patient at high risk of thrombotic and hemorrhagic complications. Case report

An attempt to preserve the knee joint in a patient on hemodialysis with stage IV lower limb ischemia with a high risk of thrombotic and hemorrhagic complications is presented. Multifocal atherosclerosis and extensive occlusion of the arteries of the lower leg ruled out the technical possibility of revascularization. The patient refused the proposed hip amputation. An attempt was made to perform amputation at the level of the lower leg. Required therapy aimed at the treatment and prevention of thrombotic complications, and optimization of microcirculation in the ischemic limb. For this purpose, a prolonged blockade of the sciatic and femoral nerves, combined anticoagulant therapy, and treatment with alprostadil were performed. Therapy with antithrombotic and vasoactive drugs was not effective and was complicated by the state of persistent hypocoagulation with an episode of bleeding. Amputation of the limb at the level of the thigh was performed according to vital indications after correction of hypocoagulation. The lack of clinical recommendations on anticoagulant therapy for critical lower limb ischemia in patients with stage 5 chronic kidney disease requires an individual approach to the choice of antithrombotic drugs and their doses, monitoring the state of blood coagulation using an integral method for assessing the hemostasis system thromboelastography.

INTRAOPERATIVE STATE OF THE HEMOCOAGULATION SYSTEM IN PATIENTS WITH OPEN AND ENDOVASCULAR REVASCULARIZATION OF INFRAINGUAL ARTERIAL SEGMENT IN THE PRESENCE OF STENOTIC-OCCLUSIVE PROCESS OF TIBIAL ARTERIES

Background. Among all postoperative complications associated with revascularization of atherosclerotic steno-occlusive process of the femoral-distal artery, thrombosis of the reconstruction segment is 6-32%. Objective. Prevention of thrombotic complications through vascular revascularization of the lower extremity by using a pathogenetically reasonable system of postoperative thromboprophylaxis. Methods. The study involved 97 patients with atherosclerotic stenotic-occlusive process of the infrainguinal artery in cases of stenotic-occlusive lesions of the tibial arteries. In order to study the state of the hemocoagulation system on patients, the methods for studying the indicators of coagulation, fibrinolytic and aggregation systems were used. Results. Development of hypercoagulable disorders in the patients who underwent endovascular revascularization of the arterial segment is more intense than in those who underwent open vascular revascularization methods. Hypercoagulation of blood at the intraoperative stage of revascularization takes place primarily due to the activity of factor IIa of the hemocoagulation cascade. Taking into account these circumstances, already at the surgery stage for thromboprophylaxis non-fractionated heparin (NFH) should be prescribed. At the same time for prevention of thromboembolic complications double anti-thrombocyte therapy: clopidogrel, acetylsalicylic acid should be prescribed. Conclusion. Hypercoagulant ability of the blood system, which develops after arterial reconstructive interventions, takes place against the background of low activity of the fibrinolytic blood system, nevertheless a gradual increase in the activity of the aggregation capacity of the blood. Development of hypercoagulable disorders at the intraoperative stage of surgery in the patients with endovascular methods of arterial reconstructions is more intense than in those treated with open methods of arterial revascularization. Taking into account these circumstances, already at the surgery stage for thromboprophylaxis an anticoagulant should be prescribed that has a targeted effect on factor IIa of the hemocoagulant cascade with simultaneous prevention of thromboembolic complications – double anti-thrombocyte therapy.

Clinical practice of emergency department-initiated extracorporeal cardiopulmonary resuscitation for cardiac arrest in adults.

Clinical practice of emergency department-initiated extracorporeal cardiopulmonary resuscitation for cardiac arrest in adults.

SOD2 in platelets: with age comes responsibility

SOD2 in platelets: with age comes responsibility

Diagnosis, management and prevention of thrombotic complications in microsurgical breast reconstruction: a review of the literature

Autologous free tissue transfer is a safe and effective option for breast reconstruction. It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life. Microvascular thrombosis is a rare but significant complication of microsurgical breast reconstruction, often resulting in flap failure. Proper diagnosis and timely management of this complication are essential to free flap salvage. While microvascular thrombosis poses a threat to flap survival, several methods may be employed to mitigate its more devastating effects. Here, we present a comprehensive review of arterial and venous thrombotic complications in both the intraoperative and postoperative settings. We discuss preoperative risk assessment, methods for flap monitoring, and operative and medical management of thrombotic complications. We present an updated algorithm for the intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our novel algorithm for the postoperative management of microvascular thrombosis.

Prevention of thrombotic complications in critically ill children

Prevention of thrombotic complications in critically ill children

Benefits and Implications of Resveratrol Supplementation on Microbiota Modulations: A Systematic Review of the Literature.

Resveratrol is a polyphenol that has been shown to possess many applications in different fields of medicine. This systematic review has drawn attention to the axis between resveratrol and human microbiota, which plays a key role in maintaining an adequate immune response that can lead to different diseases when compromised. Resveratrol can also be an asset in new technologies, such as gene therapy. PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched to find papers that matched our topic dating from 1 January 2017 up to 18 January 2022, with English-language restriction using the following Boolean keywords: (“resveratrol” AND “microbio*”). Eighteen studies were included as relevant papers matching the purpose of our investigation. Immune response, prevention of thrombotic complications, microbiota, gene therapy, and bone regeneration were retrieved as the main topics. The analyzed studies mostly involved resveratrol supplementation and its effects on human microbiota by trials in vitro, in vivo, and ex vivo. The beneficial activity of resveratrol is evident by analyzing the changes in the host’s genetic expression and the gastrointestinal microbial community with its administration. The possibility of identifying individual microbial families may allow to tailor therapeutic plans with targeted polyphenolic diets when associated with microbial dysbiosis, such as inflammatory diseases of the gastrointestinal tract, degenerative diseases, tumors, obesity, diabetes, bone tissue regeneration, and metabolic syndrome.

Тромбоэластография в акушерской практике

The study of changes in the hemostatic system in women with a complicated pregnancy is one of the promising tasks aimed at the prevention of thrombotic complications in obstetric practice. Objective. To develop treatment and prevention strategies for thrombotic complications in women staying in maternity units based on the study of hemostatic parameters using thromboelastography (TEG). Patients and methods. The pattern of coagulation disorders in the hemostatic system was examined in 343 pregnant women with obstetric complications (pre-eclampsia, placental abruption, fetal growth restriction, and preterm labor). In 220 women, hemostatic disorders were not corrected; in 123 women, the treatment strategy was determined by the results of laboratory and instrumental monitoring of the hemostatic system. Results. The area under the ROC curve (AUC) for maximum clot firmness (MA) [AUC = 0.9 (CI = 0.83–0.95), p < 0.001] was greater than for any of the blood coagulation parameters considered. The optimal classification threshold for the MA parameter is a cut-off point of 64.4. This threshold is characterized by sensitivity of 80.3% and specificity of 81.8%. Significant thresholds for thrombotic conditions are MA > 75 mm [AUC = 0.83 (95% CI 0.76–0.90)] and R < 2 min [AUC = 0.72 (95% CI 0.63–0.81)]. Conclusion. The introduction of treatment and prevention strategies based on thromboelastography in women staying in maternity units helps to avoid such complications as lower extremity thrombophlebitis, pelvic vein thrombosis, pulmonary embolism, and cerebral ischemia. Key words: pregnancy complications, prevention, thrombosis, thromboelastography

Anticoagulant therapy for stroke prevention in patients with severe COVID-19

During the pandemic of the new coronavirus infection, there is increasing evidence of neurological complications associated with COVID-19. There is no doubt that stroke can be a major complication in patients with severe disease course.Objective: to determine the safest and most effective anticoagulant for stroke prevention in patients with severe COVID-19.Patients and methods. A prospective study enrolled 520 patients with severe COVID-19. We used the following criteria for severe COVID-19: SpO2 <92% on room air at sea level, PaO2 /FiO2 <300 mm Hg, respiratory rate >30 breaths/min, lung infiltrates >50% on computed tomography. The study included 509 patients, divided into three groups depending on the type of anticoagulant therapy: patients of the 1st group received 24–36 thousand IU of heparin, patients of the 2nd group – enoxaparin at a dose of 1 mg/kg per day, patients of the 3rd group – rivaroxaban at a dose of 20 mg/day. The duration of anticoagulant administration depended on the severity of the patient's condition, dynamics of laboratory parameters (D-dimer, fibrinogen, international normalized ratio, activated partial thromboplastin time, platelet count), and varied from 2 to 6 weeks. In addition, we studied the incidence of ischemic and hemorrhagic strokes and transient ischemic attacks during a 6-week follow-up period. The article also presents a clinical case of large artery thrombosis in a young patient with severe COVID-19 without stroke risk factors.Results and discussion. Even against the background of active primary prevention, stroke incidence was 2.6% (0.6% for ischemic stroke, 1.4% for venous stroke, and 0.6% for hemorrhagic stroke). The highest stroke incidence was observed in the group of patients receiving heparin. In contrast, the prevention of thrombotic complications in patients receiving low-molecular-weight anticoagulants or rivaroxaban showed the best results with minimal morbidity and mortality in severe COVID-19.Conclusion. Stroke can be a complication of COVID-19, and preventive anticoagulant therapy using low-molecular-weight heparin or a factor X inhibitor effectively prevents this complication.

Inflammatory damage to the myocardium in patients with novel coronavirus disease (COVID-19)

The aim. To analyze current evidence about etiology, pathogenesis, clinical manifestation, diagnosis, and treatment of patients with COVID-19 associated myocarditis. Multisystem inflammatory syndrome is possible in COVID-19 including inflammatory damage to the myocardium, which may last over several months and worsen the disease outcome. Mechanisms of inflammatory cardiac damage include direct damage by SARS-CoV-2, massive release of cytokines, dysregulation of the renin-angiotensin system. All these factors can aggravate pre-existing overload of the right heart chambers in patients with multifocal pneumonia, thrombosis of coronary arteries and myocardial ischemia. Inflammation of the myocardium manifests with typical symptoms of myocarditis and pericarditis. It can be accompanied by heart failure with rapid decompensation, arrhythmia, acute coronary syndrome or even sudden death. Laboratory findings in COVID-19 associated myocarditis include high levels of CRP, BNP, NT-proBNP, and D-dimer. Transthoracic echocardiography allows for an assessment of the left ventricular dysfunction and diagnosis of a pericardial effusion. Heart MRI according to the Lake Louise Diagnostic Criteria is the most sensitive diagnostic method in acute myocarditis. Medical imaging is indicated only in cases when results obtained can potentially influence the patient management tactics and should be performed according to the shortest protocol due to high risks of virus transmission. Conclusions. ESC experts (2020) do not provide unanimous recommendations for the treatment of SARS-CoV-2 associated myocarditis, considering a lack of the evidence base. Patient management is limited to adequate treatment of heart failure, arrhythmia, acute coronary syndrome, and prevention of thrombotic complications. Ongoing studies are aiming to evaluate potential place of glucocorticoids, intravenous immunoglobulins, antibodies against IL-6 receptor, colchicine in the treatment of COVID-19.

Approaches to treatment of COVID19 from perspective of correction of endotheliopathy and prevention of thrombotic complications

The pandemic of the new coronavirus infection COVID‑19, according to recent studies, has a significant effect on vascular platelet hemostasis in its pathogenesis. The article examines the tactics of managing patients with COVID‑19 from the standpoint of assessing hemostasis disorders, the risks of thrombus formation and the correction of detected disorders.

Peculiarity of clinical course of postpericardiotomy syndrome in different methods of surgery and postoperative antithrombotic therapy.

Aim To compare features of the disease course and the effectiveness of nonsteroidal anti-inflammatory drug (NSAID) treatment of postpericardiotomy syndrome (PPS) in patients after coronary bypass (CB) surgery who were treated with antiplatelet drugs and in patients after surgical correction of heart valve disease (CHVD) who received the anticoagulant warfarin for prevention of thrombotic complications.Material and methods This study included 89 patients of whom 53 patients had underwent CB and 36 patients had underwent CHVD. At 15 [13; 15] days after surgery, the severity of inflammatory response, the state of coagulation hemostasis, and hematocrit were studied. At 5 days after the first test, blood count and measurement of C-reactive protein were repeated. Echocardiography was used to determine the presence and volume of pleural effusion. For prevention of thrombotic complications, antiplatelet drugs were administered after CB and warfarin was administered after CHVD. PPS was detected in 35 (66 %) patients after CB and 18 (50 %) patients after CHVD. The ibuprofen treatment (600 mg twice a day) was administered to all patients with PPS. If positive changes in inflammatory markers were absent during the NSAID treatment, ibuprofen was replaced with prednisolone 0.5 mg/kg body weight with subsequent laboratory and instrumental monitoring.Results Patients after CHVD treated with warfarin had higher values of international normalized ratio (INR) and activated partial thromboplastin time (aPPT) and lower values of prothrombin index (PTI), fibrinogen (p<0.001 for all), hemoglobin (p=0.0016), and hematocrit (p=0,0032) than patients after CB treated with antiplatelet drugs. 21 (40 %) patients with PPS required changing the anti-inflammatory therapy from ibuprofen to prednisolone. These patients displayed hypocoagulation, which was evident as reduced PTI (p=0.0023) and fibrinogen (p=0.0209), increased INR (p=0.0291) and aPPT (p=0.0416), and a higher incidence of pericardial effusion (p=0.0080). The insufficient effectivity of NSAIDs that required administration of prednisolone was more frequently observed in patients after CHVD (61 % vs. 29 %, р=0.037).Conclusion Hypocoagulation observed in patients after CHVD due to the anticoagulant treatment with warfarin was associated with more severe course of PPS and lower effectiveness of the NSAID treatment compared to patients after CB. This results in more frequent replacement of NSAIDs with glucocorticoids in the treatment of patients after CHVD.

Реалии применения антикоагулянтной терапии при COVID-19

Введение. Поступление вируса SARS-CoV-2 в организм человека сопровождается развитием COVID-19-ассоциированной коагулопатии, часто реализующейся в различных тромботических осложнениях. Актуальные клинические рекомендации описывают основные подходы к лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО), однако реализация их не всегда представляется возможной. В реальной практике встречается значительное количество отклонений и нарушений, в том числе носящих системный характер, связанных как с ограниченностью представлений клиницистов о патогенетических аспектах развития инфекционного процесса, так и с избыточным желанием предотвратить отдельные из них. Цель исследования: изучение состояния реальной клинической практики в области лечения и профилактики развития тромботических осложнений у пациентов c новой коронавирусной инфекцией COVID-19 (НКИ COVID-19). Материалы и методы. В основе работы лежит анонимный опрос 223 врачей-специалистов, занимающихся лечением пациентов с хроническими и острыми заболеваниями сосудов. В опросник включено 18 вопросов, описывающих отношение врачей к проблеме в целом, а также касающихся выбора тактики лечения, применения антикоагулянтных препаратов и методов контроля системы гемостаза. Результаты. Подавляющее большинство участников опроса информированы и озадачены увеличением риска тромботических осложнений при НКИ COVID-19. При этом приоритетной целью антикоагулянтной терапии (АКТ) в острой фазе заболевания участники назвали лечение COVID-19-ассоциированной коагулопатии, а в стадии реконвалесценции — профилактику ВТЭО. Максимальную степень доверия при назначении АКТ имеют низкомолекулярные гепарины. Прямые оральные антикоагулянты, несмотря на отсутствие качественных рандомизированных исследований, подтверждающих их эффективность, большая часть врачей использует на амбулаторном этапе. Вызывает озабоченность значительный разброс вариантов и невысокий процент корректных ответов в вопросах, посвященных лабораторному контролю за системой гемостаза при АКТ. Заключение. Выполненный нами анализ свидетельствует о существенном расхождении реального применения антикоагулянтных препаратов у пациентов с НКИ COVID-19 с действующими клиническими рекомендациями. Кроме того, полученные результаты свидетельствуют о необходимости повышения уровня образованности практикующих специалистов в вопросах свертывания крови. Background. The SARS-CoV-2 virus invasion lead to COVID-19-associated coagulopathy accompanied with increased incidence of thrombotic complications. Current clinical guidelines give the main approaches to the treatment and prevention of them; however their implementation is not always possible in practice. In fact, there are a lot of violations including with a systemic genesis and associated either with the low understanding of infectious process pathogenesis aspects by clinicians or with their excessive desire to prevent coagulation disturbances. the revealing of real clinical practice conditions in the treatment and prevention of thrombotic complications in patients with coronavirus infection COVID-19. Materials/Methods. We provided an anonymous poll for 223 experts treating patients with chronic and acute vascular diseases. The questionnaire included 18 questions to identify as the experts attitude to this challenge as a whole as well as to their choice of treatment tactics, and anticoagulant drugs, and methods of laboratory monitoring of blood coagulation. Results. Most participants know the increased risk of thrombotic complications in COVID-19 and they are puzzled by it The treatment of COVID-19-associated coagulopathy is considered as the priority goal of anticoagulant therapy in the acute phase of COVID-19 whereas the prevention of venous thromboembolic complications is noted as main goal in convalescences. Low molecular weight heparins have gotten the highest confidence in the administration among anticoagulants. In turn, the most of experts use direct oral anticoagulants in outpatients even despite no confirmation is for DOAC’s effectiveness from randomized trials in this time. Besides it was revealed wide spread of opinions and low count of correct responses about laboratory control of the hemostatic system and anticoagulants. Conclusion. The analysis showed a serious inconsistency between the real anticoagulants administration in patients with COVID-19 and the recommendations of clinical guidelines. This circumstance obviates the need to raise educational level of physicians and surgeons in the field of blood coagulation.

Abstract P100: Hemorrhagic Stroke in the Setting of COVID-19 is Associated With Anticoagulation Use

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

COVID-19-associated coagulopathy and anticoagulants

The patients infected with SARS-CoV-2 have a prothrombotic state. The incidence of thromboembolic complications in patients with severe disease is much higher than in those with non-severe disease. Coagulation parameters, D-dimers, fibrinogen and platelet count are important for the identification and intervention of thromboinflammation, as early as possible. Low-molecular-weight heparin and unfractionated heparin are the anticoagulants of choice in the prevention of thrombotic complications.